Pain Pump Shoulder Surgery Lawsuit Pagcl Research}

Pain Pump Shoulder Surgery Lawsuit PAGCL Research

by

Mont Wrobleski

It is not known how many people have been adversely affected by the condition known as PAGCL. However, we all have a duty to try and promote public awareness about this condition. Postarthroscopic glenohumeral chondrolysis can be caused by pain pumps that deliver medicine after shoulder surgery. Symptoms include shoulder stiffness, popping and snapping, and reduced range of motion, and usually appear several months after the procedure.

There has been a lot of research done on this topic, and we owe the scientific community and debt of gratitude. There are three studies in particular that are very interesting. The first one is called, Glenohumeral Chondrolysis After Shoulder Arthroscopy Associated With Continuous Bupivacaine Infusion by J. Rapley, R. Beavis, F. Barber – Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 25, Issue 12, Pages 1367-1373. Here is an excerpt:

Abstract Purpose – To determine the incidence of glenohumeral chondrolysis associated with the use of a continuous-infusion device in shoulder arthroscopy.

Methods – A consecutive series of patients undergoing arthroscopic glenohumeral surgery with a postoperative continuous-infusion pump inserted into either the glenohumeral joint or subacromial space were evaluated for chondrolysis. Two pump types were used: group 1 received 100 mL of 0.5% bupivacaine without epinephrine infused at 2.08 mL/h, and group 2 received 270 mL of 0.5% bupivacaine without epinephrine infused at 4.16 mL/h.

Conclusions – Chondrolysis developed in 3 of 16 patients (19%) with glenohumeral joint infusion of 0.5% bupivacaine without epinephrine at 4.16 mL/h for 65 hours. No patient using a 2.08-mL/h reservoir for 48 hours into the glenohumeral joint and no patient with a subacromial infusion device had chondrolysis. Clinical symptoms and radiographic evidence of chondrolysis developed before 12 months after surgery.

Another interesting study is called, “Pain Pump Use After Shoulder Arthroscopy As a Cause of Glenohumeral Chondrolysis by Benjamin T. Busfield, M.S., M.D.a, Denise M. Romero, M.D.b – Volume 25, Issue 6, Pages 647-652 (June 2009) – anesthesiology clinics

Here is an excerpt: Abstract – Shoulder arthroscopy has become a routine outpatient surgery. Pain control is a limiting factor for patient discharge after surgery, and several modalities are used to provide continued analgesia postoperatively. Regional anesthetic blocks and shoulder pain pumps are common methods to provide short-term pain control. Shoulder pain pumps can be used either in the subacromial space or within the glenohumeral joint. Several clinical studies suggestedwhich was confirmed by a bovine and rabbit cartilage studythat there is significant chondrotoxicity from bupivacaine, a local anesthetic commonly used in pain pumps. Postarthroscopic glenohumeral chondrolysis is a noninfectious entity associated with factors including use of radiofrequency thermal instruments and intra-articular pain pumps that administer bupivacaine, but there have been no cases reported with subacromial pain pump placement. Treatment options are difficult in a young patient with postarthroscopic glenohumeral chondrolysis, and understanding the literature with regard to risk factors is paramount to counseling patients and preventing this devastating complication.

A third study worth mentioning is called, Postsurgical Glenohumeral Arthritis in Young Adults by Allison G. McNickle, MS, Daniel R. LHeureux, BS, Matthew T. Provencher, MD, LCDR, MC, USN, Anthony A. Romeo, MD and Brian J. Cole, MD, MBA – Am J Sports Med September 2009 vol. 37 no. 9 1784-1791. Here is an excerpt: Background – Chondrolysis has been reported as a sequela of arthroscopic shoulder surgery. Although the causes have yet to be fully elucidated, basic science and clinical evidence suggest a multifactorial origin. Surgical treatment in young patients with glenohumeral chondrolysis is particularly challenging, with little outcome data. Hypothesis Glenohumeral chondrolysis has several causes and patterns of presentation. Biological resurfacing is a viable treatment option for symptomatic glenohumeral arthritis. Study Design Case series; Level of evidence, 4. Methods Twenty patients (mean age, 19.7 years; range, 13.133.8) were referred for management of extensive glenohumeral arthritis after arthroscopy glenohumeral surgery (mean time postoperatively, 26 months; range, 373). Sixteen patients had an intra-articular pain pump placed for 2 to 3 days; 2 patients demonstrated prominent implants; and 2 had thermal treatment. Patients underwent revision surgery, including 7 biological resurfacings of the glenoid and humeral head, 4 biological resurfacings of the humeral head alone, and 7 other procedures. Eight patients having biological resurfacing were assessed just before the revision surgery, at a mean time of 3.1 years after revision (range, 1.96.5), with the American Shoulder and Elbow Surgeon scale and Simple Shoulder Test, Short Form 12 (physical and mental components), and visual analog scale score for pain.

This article should not be construed as medical advice. If you found any of these excerpts interesting, please read the studies in their entirety.

Monty Wrobleski is the author of this article on

Pain Pump Shoulder Surgery Lawsuit

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Pain Pump Shoulder Surgery Lawsuit PAGCL Research}